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De Novo Standard of Review Applies – D. RI

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  • De Novo Standard of Review Applies – D. RI

    Here’s a new case out of the District of Rhode Island, Nancy A. Tullie v. The Prudential Life Insurance Company of America. In this matter, the court is only deciding the standard of review. The court first determines which plan is operative.

    After reviewing the parties' arguments and the documents themselves, the Court finds that the 2005 Flex Plan is the operative document. The Group Contract dated January 1, 2000 (ECF No. 19·4) includes a Certificate of Insurance. The 2005 Flex 2000 Plan incorporates by reference the Group Contract and the Group Certificate. The Group Contract provides that any "amendment will not affect a claim incurred before the date of change." Id at 7. The 2014 Flex Plan, amended on December 8, 2014, came after Ms. Tullie's claim was incurred and therefore it will not and cannot affect her already-filed claim. Instead, her claim continued to be governed by the language contained in 2005 Flex Plan 2000, the Plan in effect on the date she was found disabled. See DiGiovanni v. Guardian Life Ins. Co. of Am., No. CIV.A 98·10908-GAO, 2002 WL 1477175, at *2 (D. Mass. June 28, 2002). The rules providing ERISA benefits cannot unilaterally change after a person files a claim and the language from the relevant Plan document mandates this principle.
    The court then concludes that that plan does not confer discretionary authority.

    Upon review of this language in the context of the Group Contract and properly incorporated documents, the Court finds that the quoted passages in the 2005 Flex Plan 2000 do not help Prudential overcome its burden. The first two provisions are inapplicable to Ms. Tullie's claim because they both refer only to non-ERISA claims. See id at 30 (Section 7.2: Non-ERISA claims Under the Flexible Benefits Feature and dependent Care Flexible-Spending Account"). The third provision Prudential cites is contained in Supplement F, which explicitly states that supplement provisions are subordinate to “the terms of the insurance policy” and the group plan. Because neither the policy nor the Plan include any form of "safe harbor" discretionary language, the Supplement F provision does not help Prudential to make its standard of review case.
    The short opinion is attached below.
    Attached Files